Peritonitis polimicrobiana asociada a diálisis peritoneal con fracaso de la técnica: reporte de un caso y transición a hemodiálisis
Polymicrobial peritonitis associated with peritoneal dialysis with failure of the technique: a case report and transition to hemodialysis
DOI:
https://doi.org/10.19136/mhr.a11n1.6700Palabras clave:
Diálisis peritoneal, Peritonitis, Infecciones fúngicas, HemodiálisisResumen
Introducción: La peritonitis asociada a diálisis peritoneal constituye una complicación infecciosa relevante que puede ocasionar fracaso de la técnica y transferencia a hemodiálisis. La identificación oportuna de episodios refractarios y de etiología microbiológica compleja es fundamental para optimizar el tratamiento y establecer medidas para el control de la fuente de infección. Descripción del caso: Paciente masculino de 65 años con enfermedad renal crónica estadio 5 en diálisis peritoneal, diabetes mellitus tipo 2 e hipertensión arterial sistémica, quien ingresó por dolor abdominal, disnea progresiva, sobrecarga de volumen y derrame pleural bilateral de predominio derecho. El efluente peritoneal mostró 3,700 células/mm³, con 75 % de polimorfonucleares, compatible con peritonitis asociada a diálisis peritoneal. Intervenciones: Se inició tratamiento antimicrobiano empírico recomendado por la guía ISPD, posteriormente ajustado según los aislamientos microbiológicos y perfiles de susceptibilidad. Resultados: Durante la evolución se identificaron Pseudomonas aeruginosa, Escherichia coli, Staphylococcus epidermidis, Candida glabrata y Candida tropicalis. La recurrencia infecciosa, la persistencia de la respuesta inflamatoria y la identificación de microorganismos fúngicos condicionaron fracaso de la técnica. Se estableció acceso vascular temporal para hemodiálisis y se retiró el catéter Tenckhoff como medida para el control de la fuente de infección. Conclusión: El seguimiento clínico, celular y microbiológico permitió reconocer la evolución desfavorable y fundamentar el retiro del catéter peritoneal para el control definitivo de la infección. La transición a hemodiálisis aseguró la continuidad de la terapia de reemplazo renal, con evolución clínica posterior favorable.
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